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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. ..l.,� s 1 ------------------------ -- �� k.� (Complete in Duplicate) Date Issued ------ ------• -------- - -------------------------- This Perrriiif Expires 1 Year From Date Issue Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance;with County Ordinance No. S49. . 0 _' -----/ ; -------------�---�-� JOB ADDRESS AND LOCAT N- --""-"-" - - • ��• - ----------------------------------------- -------- ------------ ------------------------------------ Owner s Name. _ ��y-- - - - ----------- Address lP , = f -- P ------------- Phone Name-------- - - __ _____ _ ----------•---------- - ------------------- ---------- ---------- one..--••------------•---- ----•-- A artmY t House ❑ ❑ Motel Other ❑ Installation will serve: Residence p Commercial Trailer Court ❑ s ❑ -_ Numb of bedrooms. Number of baths _/___ Lot size �. Q- � �Qr ---------------•------- Number of living units: : O t Water Supply: Public system'.ZKCommunity system ❑ Private ❑ Depth to Water Table ft. Character of soil to a depth ofX3eei: pan C] Sand E] Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [ ard No � Previous Application Made: (If yes date � __- 1 No �/ New Construction: Yes [I No A�FHA/VA: Yes ❑ TYPE OF INSTALLATION ANb'SPECIFICATIONS: (No, septic tank or cesspool.permitted if public sewer is available within'200 feet.) ptic T�nk: Distance from no we}4___-_..__-____--Distance from foundation________________._.Material-----------._.____.__---..________--....________- No. of compartments----------------•--------Size------------------------------- Liquid dejth Capacity �, ,. Distance to nearest lot line_-.----- { is os ield: Distance from nearest well_________________Distance from on q • s Length of each line--_--- -------------Width of trench.---- ?/Oe-------------------- Number of lines_____ __. -- 9 r Type of filter mate�ialjf�� f..--Depth of.filter material__, ______. Total length_.___ _ .' Distance to nearest lot line_�------.-- -l5eepage Pit: Distance to'nearest well . -------------Distance fr fou dation___ �:k---- ON-11 -, !t ze: Diameter_ -----------Depth_�> � r Number of Ifs `---_ ."-------Lining material_- _ Cesspool: Distance from nearest well__________._"_--_Distance from foundation--------------------Lining material___-------------__"------------------ als. u id Capacity 9 ❑ Size: Diameter - ----------Depth-------------------- ------ -------------------- -Li q p . Y Distance from nearest well__-------------'_-------------------------------Distance from nearest-building_-:___.__-------------------------------- C `Privy: .'nea'rest ----- --------------- ------------------------------- 1 Distance to �crest lot line------ __"_-_ { -------------------- Remodeling,and/or repairing"(describe.�:_ - -9I ---------- ---------- ----------•-------------------------------------------------------- t . ,1 ; # ----- - --- ------ .: ,: I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State IawS,_and rules,ahcI regula+ions of +ht:- o-r„_Joaquin Local Health District. �, � - �Q -------- ---------------- --"- - _ • r Contractor) (Signed)--------------------- _ 1 BY= I (Title)- - -------- ----------------------•----------------------=------- (Piot plan, showing size'of lot, location-of-system in relati o wells, buildings, etc.,.can be placed on reverse side).. a _ .fFOR DEPARTMENT USE ONLY -__ 1 DATE-.-- � =- ;- -------- APPLICATION ------ fAPPLICATION ACCEPTED BY__- _ - REVIEWED BY i ----- i DATE - -- BUILDING PERMIT ISSUED _ ------------- DA7E--------------------------------------------- - ---------------- - - Alterations and/or recommendations:____---_ ______--------- i G�* -- --"------------------- ----- " - -:----'__________________--.__-.----''-----' ---'- - -. ------------ ------------------------ C— f --------------------------- ----------ri-----------------y-- ----- ------------------ - ..� ,Q 7Date FINAL INSPECTION BY:---------- -------- - ---------- ---- .� .-1 __'----- -- - I -y t SAN JOAQUIN LOCAL HEALTH DISTRICT r 124 Syc more Street 205 West 9th Street 1601 E.Ha:elton Ave. ,BOO.West Oak•Street _ -111� \ ♦ �� t 4., 2 Trac California Stockton,California Lodi,California Manteca,California Y, Ce 9 REVISED 8.59 3M 3-163 F.P.CO.